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SIGNATURES <br /> CITY OF CT a,,�e-S PLANNING OFFICIAL: <br /> Acv <br /> (Print Name) P L(Signature) <br /> et" e e <br /> a--llo-ao�o (t I .Sarbcvn Avv w 503 -ZR7 a-L o 9 <br /> DATE ADDRESS , ore_ t ib TELEPHONE# <br /> * COUNTY PLANNING OFFICIAL <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> DATE ADDRESS TELEPHONE# <br /> *If necessary,depending upon city/county agreement on jurisdiction outside city limits but within UGB. <br /> G:\FORMS\SEPTIC\Application Packets\S-39 LUCS.doc MC:S-39 rev: 8/10,04/12 <br />